پرسش [ سوالات تستي براي دانشجويان پزشكي ]

[Himmler 22,171]

21

A 55-year-old African American female presents to the ER with lethargy and blood pressure of 250/150. Her family members indicate that she was complaining of severe headache and visual disturbance earlier in the day. They report a past history of asthma but no known kidney disease. On physical exam, papilledema and retinal hemorrhages are present. The best approach is

 

A)

Intravenous labetalol therapy

B)

Continuous-infusion nitroprusside

C)

Clonidine by mouth to lower blood pressure slowly but surely

D)

Nifedipine sublingually to lower blood pressure rapidly and remove the patient from danger

E)

Further history about recent home antihypertensives before deciding current therapy

[Himmler 22,171]

25

A 50-year-old construction worker continues to have an elevated blood pressure of 160/95 even after a third agent is added to his antihypertensive regimen. Physical exam is normal, electrolytes are normal, and the patient is taking no over-the-counter medications. The next helpful step for this patient is to

 

A)Check pill count

B)Evaluate for Cushing syndrome

C)Check chest x-ray for coarctation of the aorta

D)Obtain a renal angiogram

E)Obtain an adrenal CT scan

[Himmler 22,171]

28

 

An asymptomatic 30-year-old female was noted by her gynecologist to have a cardiac murmur. She was referred for an echocardiogram, with results reported to her as showing mitral valve prolapse. The patient desires more information and now comes to you. Which of the following is true about her condition

؟؟

 

A)Echocardiography demonstrates displacement of one or both mitral valve leaflets posteriorly into the left atrium during systole

B)Migration of the systolic click and systolic murmur toward the first heart sound will occur during squatting

C)Prophylactic beta blocker therapy is indicated

D)Significant mitral regurgitation is likely to occur (>50% chance) sometime in her life

E)Restriction of exercise is advised to reduce the risk of sudden cardiac death

[Himmler 22,171]

29

You are reviewing a number of patients with congenital heart disease with specific attention to whether or not they need antibiotic prophylaxis for dental work. Which of the following cardiac conditions creates the lowest risk for development of infective endocarditis

؟؟

 

A)Coarctation of the aorta

B)Ventricular septal defect

C)Atrial septal defect

D)Patent ductus arteriosus

E)Prosthetic heart valve

[Himmler 22,171]

30

An 80-year-old with a past history of myocardial infarction is found to have left bundle branch block on ECG. He is asymptomatic with blood pressure 130/80, lungs clear to

auscultation, and no leg edema. On cardiac auscultation, the most likely finding is

 

A)Fixed (wide) split S2

B)Paradoxical (reversed) split S2

C)S3

D)S4

E)Opening snap

F)Midsystolic click

[Himmler 22,171]

21p

Which of the following statements best describes long-acting nitrate preparations

?

 

A)Tolerance often develops

B)Their effect can be blocked by high doses of beta2 selective inhibitors

C)Transdermal patches are more likely to be associated with headaches than are sublingual nitrates

D)Oral preparations are more effective than sublingual ones

E)Oral administration of isosorbide should not exceed 15 mg every 3 to 4 h

[Himmler 22,171]

22p

 

A 70-year-old retired banker with no past medical history presents to the emergency department 4 h after the onset of severe substernal crushing chest pain with radiation to the left arm and neck. Electrocardiography reveals significant ST-segment elevation in leads I, L, V5, and V6. The patient has no clear-cut medical contraindications to anticoagulation. Which of the following would be the optimal management strategy at this time

?

 

A)Intravenous tissue plasminogen activator alone

B)Intravenous tissue plasminogen activator and aspirin

C)Intravenous tissue plasminogen activator and heparin

D)Intravenous tissue plasminogen activator, heparin, and aspirin

E)Thrombolytic therapy is contraindicated because of the patient's age

[Himmler 22,171]

23p

A 14-year-old boy is brought into the emergency room pulseless and undergoing cardiopulmonary resuscitation. He collapsed while playing basketball. There is no history of trauma, and no prior history of cardiovascular disease. Which of the following conditions would most likely be identified at the time of autopsy

?

 

A)Normal findings

B)Anomalous left coronary artery

C)Ruptured aorta

D)Hypertrophic cardiomyopathy

E)Coronary artery disease

[Himmler 22,171]

24p

A previously healthy 58-year-old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 90/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge, 4 mmHg; pulmonary artery, 22/4 mmHg; and mean right atrial, 11 mmHg. This man would best be treated with

 

A)fluids

B)digoxin

C)norepinephrine

D)dopamine

E)intraaortic balloon counterpulsation

[Himmler 22,171]

25p

A 63-year-old black woman with a long history of hypertension and diabetes is brought to the emergency department by relatives because she has become incoherent over the past 24 h. Physical examination reveals a disoriented woman whose blood pressure is 230/160, respiratory rate is 25, and pulse is 110. The patient is afebrile. The chest reveals bibasilar rales. Cardiac examination is remarkable only for the presence of an S4. There is no organomegaly or focal neurologic findings. The patient is oriented to person only

The family revealed that the patient has not been taking her antihypertensive medicines in the past several weeks. The patient is placed on a cardiac monitor, and both intravenous and intraarterial lines are placed. An emergent CT scan reveals no evidence of hemorrhage or mass lesion. The most appropriate next step in

management would be to

 

A)observe the patient in a quiet room for 1 h before administering therapy

B)wait for laboratory values to return before deciding on specific therapy

C)administer sodium nitroprusside

D)administer diazoxide

E)administer intravenous nicardipine

[Himmler 22,171]

Quiz for Students

 

 

 

1

A 30-year-old male patient complains of fever and sore throat for several days. The patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the following is the best course of action

?

 

A)

Begin outpatient treatment with ampicillin

B)

Culture throat for b-hemolytic streptococci

C)

Admit to intensive care unit and obtain otolaryngology consultation

D)

Schedule for chest x-ray

[Himmler 22,171]

2

A 70-year-old patient with long-standing type 2 diabetes mellitus presents with complaints of pain in the left ear with purulent drainage. On physical exam, the patient is afebrile. The pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The peripheral white blood cell count is normal. The organism most likely to grow from the purulent drainage is

A)

Pseudomonas aeruginosa

B)

Staphylococcus aureus

C)

Candida albicans

D)

Haemophilus influenzae

E)

Moraxella catarrhalis

[Himmler 22,171]

3

You are a physician in charge of the patients who reside in a nursing home. Several of the patients have developed influenza-like symptoms, and the community is in the midst of an influenza A outbreak. None of the nursing home residents have received the influenza vaccine. What course of action is most appropriate

?

A)Give the influenza vaccine to all residents who do not have a contraindication to the vaccine (i.e., allergy to eggs

B)Give the influenza vaccine to all residents who do not have a contraindication to the vaccine; also give amantadine for 2 weeks

C)Give amantadine alone to all residents

D)Do not give any prophylactic regimen

[Himmler 22,171]

4

An elderly male develops fever 3 days after cholecystectomy. He becomes short of breath, and chest x-ray shows a new right lower lobe infiltrate. Sputum Gram stain shows gram-positive cocci in clumps, and preliminary culture results suggest staphylococci. The initial antibiotic of choice is

A)Penicillinase-resistant penicillin such as nafcillin

B)Vancomycin

C)Antibiotic therapy should be based on the incidence of methicillin-resistant staphylococci in that hospital

D)Quinolones have become the drug of choice for pneumonia

[Himmler 22,171]

5

A 30-year-old male with sickle cell anemia is admitted with cough, rusty sputum, and a single shaking chill. Physical examination reveals increased tactile fremitus and bronchial breath sounds in the left posterior chest. The patient is able to expectorate a purulent sample. Which of the following best describes the role of sputum Gram stain and culture

??

A)

Sputum Gram stain and culture lack the sensitivity and specificity to be of value in this setting

B)

If the sample is a good one, sputum culture is useful in determining the antibiotic sensitivity pattern of the organism, particularly Streptococcus pneumoniae

C)

Empirical use of antibiotics for pneumonia has made specific diagnosis unnecessary

D)

There is no characteristic Gram stain in a patient with pneumococcal pneumonia

[Himmler 22,171]

6

A 30-year-old man who has spent 5 of the last 10 years in prison in New York City is referred from the prison because of hemoptysis. He has a history of tuberculosis diagnosed 3 years ago and took isoniazid and rifampin for about a month. A cavitary lesion is seen on chest x-ray. The physician should do all the following except

 

A)

Obtain sputum for acid-fast bacilli (AFB) stain, culture, and sensitivity

B)

Start supervised isoniazid and rifampin administration

C)

Start a supervised multiple drug combination to treat multidrug-resistant tuberculosis

D)

Place the patient in respiratory isolation

E)

Perform routine screening of inmates and staff for tuberculosis

[Himmler 22,171]

7

A recent outbreak of severe diarrhea is currently being investigated. Several children developed bloody diarrhea, and one remains hospitalized with acute renal failure. A preliminary investigation has determined that all the affected children ate at the same restaurant. The food they consumed was most likely to be

A)Pork chops

B)Hamburger

C)Gefilte fish

D)Sushi

E)Soft-boiled eggs

[Himmler 22,171]

8

A 40-year-old female nurse was admitted to the hospital because of fever to 103-F. Despite a thorough workup in the hospital for over 3 weeks, no etiology has been found, and she continues to have temperature spikes greater than 102-F. The least likely diagnosis in this patient is

A)Occult bacterial infection

B)Influenza

C)Lymphoma

D)Adult Still's disease

E)Factitious fever

[Himmler 22,171]

9

In a patient who has mitral valve insufficiency, which procedure does not require prophylactic antibiotic therapy

?

 

A)Cardiac catheterization

B)Prostatectomy

C)Cystoscopy

D)Tonsillectomy

E)Periodontal surgery

[Himmler 22,171]

10

Rabies, an acute viral disease of the mammalian central nervous system, is transmitted by infective secretions, usually saliva. Which of the following statements about this disease is correct

?

 

A)The disease is caused by a reovirus that elicits both complement-fixing and hemagglutinating antibodies useful in the diagnosis of the disease

B)The incubation period is variable, and, although 10 days is the most common elapsed time between infection and symptoms, some cases remain asymptomatic for 30 days

C)Only 30% of infected patients will survive

D)In the United States, the skunk and the raccoon have been important recent sources of human disease

E)Wild animals that have bitten and are suspected of being rabid should be killed and their brains examined for virus particles by electron microscopy